World Health Organization Coronavirus Press Conference Transcript May 20

Tarik: (00:00) From WHO headquarters here in Geneva, my name is Tarik, and welcome to this regular press conference on COVID-19. You can watch us on different WHO platforms, and journalists who are online can click Raise Hand and try to get in line for questions, and try to be short and have only one question. We will get to the session of questions and answer after the opening remarks of Dr. Tedros, who is accompanied today by Dr. Maria Van Kerkhove and Dr. Mike Ryan. So I will give the floor immediately to Dr. Tedros. Dr. Tedros: (00:42) Thank you. Thank you, Tarik. Good morning, good afternoon, and good evening. Yesterday, we concluded a very productive World Health Assembly. We saw unprecedented solidarity with heads of government, heads of state, from around the world, beaming into the World Health Assembly to discuss lessons, challenges, and collective next steps to tackle the pandemic. I would like to use this opportunity to thank those heads of states and governments who participated, President Sommaruga, President Ramaphosa, President Xi, President Moon, President Macron, President Duque, President Benitez, Chancellor Merkel, Prime Minister Mottley, Prime Minister Tshering, Prime Minister Pedro Sanchez, Prime Minister Conte, Prime Minister Natano, Prime Minister Nguyen Xuan Phuc, President von der Leyen, Secretary General Guterres, and all member state representatives, ministers, for joining the assembly and signing up to a historic consensus resolution on COVID-19 and the way ahead. Dr. Tedros: (02:17) The resolution sets out a clear roadmap of the critical activities and actions that must be taken to sustain and accelerate the response at the national and international levels. It assigns responsibilities for both the WHO and its Member States, and captures the comprehensive whole of government and whole of society approach we have been calling for since the beginning of the outbreak. If implemented, this would ensure a more coherent, coordinated, and fairer response that saves both lives and livelihoods. The landmark resolution underlines WHO's key role in promoting access to safe, effective health technologies to fight the pandemic. Dr. Tedros: (03:16) I welcome Member States' commitment to lift all barriers to universal access to vaccines, diagnostics, and therapeutics. This includes four critical points from the resolution. First, that there is a global priority to ensure the fair distribution of all quality essential health technologies required to tackle the COVID-19 pandemic. Second, that relevant international treaties should be harnessed where needed, including the provisions of the TRIPS agreement. Third, that COVID-19 vaccines should be classified as a global public good for health in order to bring the pandemic to an end. And fourth, that collaboration to promote both private sector and government-funded research and development should be encouraged. This includes open innovation across all relevant domains and the sharing of all relevant information with WHO. Dr. Tedros: (04:24) An important collaborative response to this resolution will be the COVID-19 technology platform proposed by Costa Rica, which we will launch on 29th of May, which aims to lift access barriers to effective vaccines, medicines, and other health products. We call on all countries to join this initiative. Dr. Tedros: (04:52) I'm glad we're making progress on the research and development agenda, which was mapped out in February at the research and development meeting convened by WHO. That roadmap has now given rise to the Solidarity trials, which now include 3000 patients in 320 hospitals across 17 countries, and to the access to COVID-19 tools accelerator. Dr. Tedros: (05:27) We still have a long way to go in this pandemic. In the last 24 hours, there have been 106,000 cases reported to WHO, the most in a single day since the outbreak began. Almost two-thirds of these cases were reported in just four countries. But in good news, it has particularly impressive to see how countries like the Republic of Korea have built on their experience of MERS to quickly implement a comprehensive strategy to find, isolate, test, and care for every case and trace every contact. This was critical to the Republic of Korea curtailing the first wave, and now quickly identifying and containing new outbreaks. Dr. Tedros: (06:29) However, we're very concerned about the rising numbers of cases in low and middle income countries. Governments in the assembly outlined their primary goal of suppressing transmission, saving lives, and restoring livelihoods. And WHO is supporting Member States to ensure supply chains remain open and medical supplies reach health workers and patients. As we battle COVID-19, ensuring health systems continue to function is an equally high priority, as we recognize the risk to life from any suspension of essential services like child immunization. Dr. Tedros: (07:21) COVID-19 is not the only challenge the world is facing. The climate crisis is causing increasingly strong storms, abnormal weather patterns, and catastrophic shocks. Super cyclone Amphan is one of the biggest in years, and is currently bearing down on Bangladesh and India. Our thoughts are with those affected, and we recognize that like with COVID-19, there is a serious threat to life, particularly the poorest and the most marginalized communities. WHO continues to offer support to Bangladesh and India to tackle both COVID-19 and the effects of the super cyclone. Dr. Tedros: (08:14) I want to end by emphasizing that there is continued hope. The last person who was being treated for Ebola in the Democratic Republic of Congo recovered and was discharged on May 14. On that day, the DRC Ministry of Health announced the beginning of the 42-day countdown to the end of the outbreak. We now have 36 days to go, but new cases could still emerge, as we have seen before. Dr. Tedros: (08:47) The pandemic has taught and informed many lessons. Health is not a cost. It's an investment. To live in a secure world, guaranteeing quality health for all is not just the right choice, it's the smart choice. I thank you. Tarik: (09:18) Thank you, Dr. Tedros, for these opening remarks. Before we open the floor to questions, just to remind the journalists that you can ask question in six UN languages, Russian, English, French, Spanish, Arabic, Chinese, as well as in Portuguese and Hindi. And you will also be able to listen to translation, for which we thank our interpreters who are here with us today. So we will open the session with questions with Luiza Duarte from CNN Brazil. Luiza, you will need to unmute yourself, and then we will be able to hear you. Luiza Duarte: (09:59) [foreign language 00: 10:04]. Translator: (10:08) Thank you for taking my question. What do you think about Brazil's decision to change the national protocol regarding the use of hydroxychloroquine in order to treat COVID-19? Dr. Mike Ryan: (10:32) Wasn't expecting such a short question. Every sovereign nation, particularly those with effective regulatory authorities, is in a position to advise its own citizens regarding the use of any drug. However, from the... and the hydroxychloroquine and chloroquine, or any licensed products with indications for many diseases... I would point out, however, that at this stage, hydroxychloroquine nor chloroquine have been as yet found to be effective in the treatment of COVID-19, or in the prophylaxis against coming down with the disease. In fact, the opposite, in that warnings have been issued by many authorities regarding the potential side effects of the drug. And many countries have limited its use to that of clinical trials, or during clinical trials, or under the supervision of clinicians in a hospital setting. That's specifically for COVID-19, because of a number of potential side effects that have occurred and could occur. Dr. Mike Ryan: (11:50) Having said that, again, it is for each national authority to weigh and assess the evidence for and against the use of this drug. As the Director-General has said, we currently have underway Solidarity trials across multiple countries, for which hydroxychloroquine and chloroquine are included as part of those clinical trials. And as WHO, we would advise that for COVID-19, that these drugs be reserved for use within such trials. Dr. Maria Van Kerkhove: (12:17) Maybe I could just add, so just an update on the Solidarity trial. So as Mike just said, that hydroxychloroquine is one of the study arms, as is remdesivir, lopinavir, ritonavir, and interferon beta-1a. And as that trial is currently underway, we are very grateful for a very large number of countries who are setting up systems in place to enroll patients and who are willing to enroll patients in this clinical trial. And as of today, we have more than 3000 patients enrolled from 320 hospitals in 17 countries. And so that is, it's a show of solidarity and called the Solidarity trial. But it's a, really, show of collaboration and willingness to work towards a common goal of understanding which therapeutics are safe and effective against COVID-19. Tarik: (13:16) Thank you, Dr. Ryan and Dr. Van Kerkhove. Thank you, Luiza, for this question. Now, we will go to Mexico where we should have [Paulina Alcazar 00:00:13:25] from EnCadena. Paulina, do you hear us? Paulina Alcazar: (13:31) [foreign language 00:13:34] Translator: (13:35) Yes. Can you hear me? Yes, please go ahead. Yes. I would like to greet all of you from Cancun. We are a very touristic location. Currently, we have 47,000 hotel rooms which have been canceled, but authorities are thinking of opening up- Speaker 2: (14:03) But authorities are thinking of opening up again progressively. What do you think should be kept in mind in order to open up areas again in sectors such as tourism? Dr. Maria Van Kerkhove: (14:16) So, thank you for this question. This is a question we get quite often with many areas wanting to open back up their economies, to get back to some normal life, a new normal of what we've been calling it. There are ways in which, as you said, to progressively get back to opening up the hotels and resuming some tourism. As we've been saying for a number of weeks now, this really needs to be done carefully and it needs to be done in a way that takes into consideration a number of factors. In the area that you're in, you mentioned Cancun, it's important that it's understood what the transmission looks like. What is the intensity of COVID-19 transmission in that area? Is it under control, in the sense that do we know where the virus is? Are case numbers increasing or decreasing? Dr. Maria Van Kerkhove: (15:10) Do you have the public health infrastructure in place and workforce in place to identify the virus in people, to find cases, isolate cases, care for those cases in medical facilities? Do you have a workforce in place to be able to trace contacts and quarantine those contacts? Are there systems in place within the tourism sector, as you mentioned, in terms of the hotels and the other facilities to be able to rapidly identify cases, to protect people who come in, in terms of ensuring physical distancing and disinfectants? So there's a number of considerations that need to be taken into account when considering opening up areas for tourism. Dr. Maria Van Kerkhove: (15:57) We have a number of guidance materials that are out for different sectors, as it relates to resuming travel, as it relates to having safe and confident travel, including hotels and guidance around the appropriate use of disinfecting areas and ensuring that's done regularly and safely. So it's a long answer because there's a lot of considerations that need to be taken into account. Having said that, if it's done in a controlled and a slow way in which systems are in place to rapidly identify cases, that's what decision makers need to look out for and do this in a data-driven and a controlled way. Dr. Michael Ryan: (16:41) If I just might add, the private sector have shown over many decades how responsive they are to the needs of their customers. I do think as the tourism sector opens up, and it's a very important sector for many countries, that clients and customers are going to not just look for levels of comfort and levels of ... Everyone wants to get away, everyone has some business travel and needs a safe place to stay as well. So I think clients are going to respond to those companies who provide them with an environment that's safe, that's managed, that's still comfortable, that's still possible to have fun. It's still possible to relax. It's still possible to do business, but it's still possible to have that fun and do that business in an environment in which the company or the group is providing the safest possible environment for people to have that experience. Dr. Michael Ryan: (17:37) I think if the private sector work with government guidelines and do that in a systematic and consistent way, then we can have the kind of opening up that is safe. Customers look to the private sector to give them a safe and fun experience. So we hope that that's the case. Those companies that invest in that now, I believe consumers will see that evidence very quickly in those companies who react to the consumers' demands and the consumers' needs in the coming weeks. Chair: (18:10) Next question. Thanks Paulina from Mexico for this question. Next is Sarah Reeton from politico. Speaker 5: (18:18) Thank you. Thank you for taking my question. Sorry, I'm going to ask a different question actually. The WHA resolution passed yesterday called for a review to be started at the earliest appropriate moment. Could you please talk a little bit about what that means to you, when the earliest appropriate moment would be? Dr. Tedros: (18:52) Thank you. Thank you so much for that question. I think the resolution from the assembly is something that we have been saying. That there should be an assessment, there should be a review to understand everything, to learn lessons, and then to address if there are problems. This is not new. It has been done after Ebola and it has been done after SARS, and it has been done after major outbreaks. So this is in WHO's DNA. I have said I will, not just the resolution, but before the resolution was endorsed, that we will do this at the earliest possible time. This means when all the conditions we need are actually met. So we will consider several conditions, but we want to do it at the earliest possible time. I say the time, and again, that WHO calls for accountability more than anyone. It has to be done. When it's done, it has to be a comprehensive one and it will involve all actors and it will check all actors. Then we know everything in a very comprehensive way, so it can help us to learn from it and make the future actually better. Dr. Michael Ryan: (20:44) May I just add that I believe there were approximately 35 operative paragraphs in the resolution. One of which dealt with the idea of evaluation, 34 of which dealt with how to end this pandemic and how to do that fairly. The actual operative paragraph just before the one related to evaluation was actually focused on scaling up development, manufacturing, distribution capacities needed for a transparent, equitable, and timely access to safe, quality, affordable, and efficacious diagnostics, therapeutics, and medicines, and many others are quite similar. So I think there was a great balance in the resolution. One operative paragraph instructing Member States and WHO to act on evaluation. 34 or so asking for more action on the pandemic response. Chair: (21:48) Thank you Dr. [Ran 00:21:48] And Dr. Tedros Next question is coming from China Daily. That's a [Chin Hue Wa 00:07:56] Can you hear us, please? Speaker 7: (22:00) Yes. Dr. [inaudible 00:22:03] I have a question about ... you mentioned that there's a lot of solidarity from the world leaders and we actually heard that. Definitely, there is a distracting voice. I don't know how disturbed you are by letter from US President Trump. Are you going to respond to that kind of ultimatum? If yes or if you're just going to ignore that? Thank you. Dr. Tedros: (22:36) Thank you. Thank you so much. As you rightly say, there was a lot of support and vote of confidence. On the letter, we have of course received the letter and we're looking into it. Thank you so much. Chair: (22:52) Thank you. Let's go now to Imogen from PBC. Imogen? [crosstalk 00:23:02] Speaker 8: (23:01) Hello. Hi. Thanks taking my question. Similar question, more detail. The president of the United States has given you 30 days to improve. He says, although I know he hasn't said what improvements he wants, or he will cut US funding completely. What are you going to do simply? Dr. Tedros: (23:26) So the answer is simply we have received the letter and we're looking into it. Thank you again. Chair: (23:34) So I think this answers this question for anyone else who would like to ask on that. Let's try to have Corinne from Bloomberg. Corrine? Please unmute yourself. Speaker 9: (23:53) Hi, can you hear me? Chair: (23:54) Yes. Corinne, please. Speaker 9: (23:57) Sorry. I'm not going to ask about the letter, but I was wondering if you have any idea on if they do pull their funding permanently, have you maybe already started talking to other Member States, that they might increase their funding or maybe even an overhaul of how the funding might occur in the future? Dr. Tedros: (24:25) On funding, WHO's budget is very, very small, by the way. It's not more than 2.3 billion US dollars a year, and that's very small and equivalent to an annual budget of a medium hospital, a medium sized hospital in a developed world. Imagine a budget of a medium sized hospital in a developed world for WHO, which is actually working in the whole world. So that's small. Because of that, in order to expand our programs and make a difference in the world, and help countries who need support as part of the transformation agenda, we have developed an investment case. The first investment case, by the way, and we have developed a strategic plan to mobilize resources. Not only that, we have also developed a strategy to build a WHO foundation, which we hope will be established soon, and looking for new sources of funding and also expand our donor base. So this had started as soon as I became director general, when we started the transformation three years ago. So we're working on it and we hope that the challenges we are facing with regard to financing will be resolved. As I said, this is part of the transformation and has nothing to do with the current situation. Hopefully when this strategy actually is implemented, we have started already implementing. Dr. Tedros: (26:53) We don't see it in terms of just mobilizing funding, but we will expand and strengthen our programs, and deliver better to the world, to those who need our service. So that's one. So we should see it in that respect. It's not about having more money and less, but it's about the programs or the different priority areas that the world needs, that we should really expand. So let's see it that way. Then that needs money and we have a complete strategy to raise funding, so it was already there. The second part: the second part is in the 1970s and '80s, the flexible funding for WHO that comes as assist contribution from Member States was more than 80%. Now in 20- Dr. Tedros: (28:00) ... and now, in 2020, the proportion of funding that comes as flexible funding, which is access contribution, is 20%. While the voluntary contribution and market funding is 80%. So it's a complete reversal. I repeat, maybe I'm not clear on this, in the 1980s the flexible funding was 80%, and now the flexible funding in 2020 is 20%. Meaning, it's not the amount of money only the problem, which I said 2.3 billion is more. The quality of it is also poor. So we need to improve the quality, too. When we started this strategy as part of the transformation, the objectives are two; increase funding, and improve the quality of the funding itself. And that's what we're doing, and I hope this will bring better results. What we have designed, we have already started implementing. And we will expect more money, but more importantly, better quality money. Thank you. Dr. Michael Ryan: (29:35) If I could just supplement on the emergency side because the greatest concern we have, and the DG has spoken to our core budgets and others, much of the US funding that reaches us here actually goes directly out in the emergencies program to humanitarian health operations all over the world. In all sites of fragile and difficult settings. It's of the order of 200 million, or 100 million a year. Which is actually the greatest proportion of funding that we receive from WHO within the emergencies program. Dr. Michael Ryan: (30:12) So, my concerns today are both for our program and, as the DG has outlined, working on how we improve our funding base for WHO's core budget. Replacing those life saving funds for frontline health services in some of the most difficult places in the world. We'll obviously have to work with other partners to ensure that those funds can still flow. So this is going to be a major implication for delivering essential health services to some of the most vulnerable people in the world. And we trust that other donors will, if necessary, step in to fill that gap. Dr. Tedros: (30:57) Next question comes from INDIA TV, Independent News Service. And we have with us [Sidhanta Multani 00:03:05]. Can you hear us? Yes, please. Yes, we can hear you. Speaker 10: (31:13) Good evening, everyone. Dr. Tedros, my question is basically a two part question. India has become the 11th country in the world to cross 100,000 COVID-19 cases. So how do you see this graph going forward? Do you think the measures they are taking in India are adequate? And part two is basically on research and trials of the vaccine that is going on around the world. We've seen that the process has been fast tracked in recent times, looking at the rising number of cases. Do you think that this accelerated timeline for manufacturing of a drug or vaccine is safe, given that normal timelines in such situations is far longer? So how do we eliminate that the longterm side effects are not there? Dr. Tedros: (31:53) [Sidhanta 00:00:31:57], you are new to us but we always stress that we have one question per journalist. Thank you. Dr. Michael Ryan: (32:05) I will begin and Maria will come in, I think, on the timelines on vaccines and other issues. So first of all, our thoughts are with the people in Northeastern India and Bangladesh as you face the potential impact of the cyclone Amphan. We know that the Bangladeshi and the Indian authorities are making some quite incredible preparations for the arrival of that huge storm. And we trust that that everyone can be kept as safe as possible. Dr. Michael Ryan: (32:41) With regard to the epidemic itself, India continues to do a very good job in combating the epidemic and trying to manage and balance controlling COVID-19 with the economic and social consequences of that. It's still early for India, as it is for many countries in South Asia. We continue to provide operational, technical, and scientific support to India from our regional office. Which is actually based in Delhi, under the leadership of Poonam Singh, our Regional Director. Dr. Michael Ryan: (33:19) And we will, as I said, also rely on India. India has a massive capacity for vaccine production, as well. India is not a beneficiary of vaccines, India produces vaccines. High quality vaccines that are delivered all over the world. And as such, has some superb companies, both in the public and the private sector, that are working already with WHO on developing vaccination solutions. So we look forward to that continued partnership with India, both in the public and the private sector. Dr. Michael Ryan: (33:52) And Maria can take you through some of the issues regarding the timelines on vaccine. WHO, just to remind everybody, there are no shortcuts here. There are things we can do faster and better, there are things we can do in parallel. But there are no shortcuts on safety. There are no shortcuts on efficacy. It's really, really important that when we say we wish to go faster, we wish to be as efficient as possible, but still complete every step that's necessary in delivering a safe and efficacious vaccine. Maria? Dr. Maria Van Kerkhove: (34:28) Thanks, Mike. So yes, absolutely. There's a number of things that the WHO is doing to support the development of vaccines around the areas of global collaboration and coordination. Making sure that the methods that are being used to evaluate and develop these vaccines are robust, they're strong, they're scientifically sound, they're ethically sound. And working to collaborate, to bring together the different partners of scientists, and public health professionals, and leaders, and manufacturers to accelerate not only their development, but ensure that when we do have vaccines that there is equitable access to this vaccine. Dr. Maria Van Kerkhove: (35:08) We are currently mapping the vaccine candidates that are underway, that are in development. There's more than 120 vaccine candidates and I'm sure there's far more than even we're mapping. Some of these are in clinical evaluation, which means they're being tested in people. And some are in preclinical evaluation. Dr. Maria Van Kerkhove: (35:28) I do want to mention, that for some vaccine candidates we had a bit of a headstart in the sense that many of these candidates started their development prior to the emergence of COVID-19. And they began with SARS, and they began with MERS. And so some of them are a little bit further along. But it's important that as these vaccines are developed, we ensure that they fit and they meet all of their criteria to be safe and effective. As Mike said, there is absolutely no shortcut to that. So when we say accelerate the development, we mean accelerate this because there's a really urgent need. But that does not mean that we will skip any steps, that anyone will be allowed to skip any steps, to ensure that we have a safe and effective vaccine. Dr. Maria Van Kerkhove: (36:18) But again, it's not only having a safe and effective vaccine. It's ensuring that we have the production capacity in place. We have the systems in country in place. So when we do have this, we will be able to actually deliver this at the population, at the people level to people who want this vaccine. Dr. Tedros: (36:38) The next question comes from Greece. We have [Costas 00:36:42] us from ERT. [Costas 00:00:36:53], are you with us? Can you unmute, please? Dr. Tedros: (36:57) Hello? Do we have- Speaker 11: (37:00) Yes. Do you hear me? Dr. Tedros: (37:01) Yes. Yes, now it's okay. Speaker 11: (37:04) Thank you for taking my question. In the last few days two studies have been published in China and Germany. One that deals with the relationship between age and transmission of the virus, and the second investigates the virile load depending on age. They show that the closure of schools works against the transmission and that children have the same virile loads as others. Based on these new studies, do you think that the opening of school can became dangerous in the next weeks and create new sources of coronavirus transmission? Dr. Maria Van Kerkhove: (37:44) So thank you for the question. In fact, your one question has several components, very important components in terms of our understanding about the infection in people in different age groups, as well as transmission. We are looking at all of these factors. The first one is about the infection by age group. So of the reported cases that we have, to date, children seem to be less affected in terms of the number of cases that are reported by a country. We have a database that we are keeping here at the global level, from reports from countries. It doesn't contain all of the four and a half million cases plus that have been recorded to date, but it does contain a large number of those. And among the cases that are reported, if you look at individual country reports, children represent around 3% up to 5% in some countries of the total reported cases. Dr. Maria Van Kerkhove: (38:45) Second part of that question is looking at whether or not they can transmit. There are a number of studies right now, and I'm looking at a slide set that I have, because one of the important areas we want to understand is how are people infectious? And when are people infectious? And how do we measure that in individuals? And what we know from the studies is that people can be infectious, mild patients can be infectious for up to nine days. People who are hospitalized can be infectious for longer, which is why it's absolutely critical that cases are isolated. And this is why as part of the strategy, cases need to be isolated and contacts need to be followed and quarantined. Dr. Maria Van Kerkhove: (39:28) Children are susceptible, just as adults are, and they can transmit as well. From some of the studies that we know from the household transmission studies, children seem to be infected from their parents, from adults that are living in that household. But it doesn't mean that it can't happen the other way around. Dr. Maria Van Kerkhove: (39:49) The question around schools being opened. A number of countries across the globe have closed schools as part of their measures to put in place, but not all countries did that. And so, as some countries in Europe right now are lifting some of their so-called lockdown measures, these public health and social measures, some of them are considering opening their schools or have opened their schools. And just as we mentioned around the tourism industry, it's important in the areas where you're considering opening schools to look at the context, look at the transmission intensity in that area. Dr. Maria Van Kerkhove: (40:26) Is transmission controlled? Are there decreasing numbers of cases? And as schools are opened, can they be opened in a safe way in which physical distancing can be maintained? Perhaps, there may be a way in which some children can go back half of the classroom, or the other classroom... There's a lot of considerations that need to be put in place. But we do need to watch very carefully, in situations where the lockdowns are being lifted, we need to look at all age groups, including children. And ensure that we have systems in place, the surveillance is in place, so that we could detect cases quickly. Dr. Tedros: (41:08) Thank you, Dr. Van Kerkhove. Now we will go to Jamey Keaten from Associated Press. Jamey? Do we have Jamey? Jamey Keaten: (41:21) Greetings- Dr. Tedros: (41:24) Hello? Jamey Keaten: (41:25) Can you hear me? Dr. Tedros: (41:25) Yes. Please, go ahead. Jamey Keaten: (41:27) Hi. I just had a follow up to an earlier question. Dr. Tedros or Mike, if you could give us a little bit of a sense as to when this review could happen? If it's going to wait until the end of the pandemic, or if you see that it could happen before then? Thank you. Dr. Tedros: (41:55) I think we have answered this earlier and we would do it at the earliest time possible- Dr Tedros: (42:02) And we would do it at the earliest time possible and then we will see all the conditions we need actually to do it, and we will do all the consultations we need. So, I hope you will bear with us. Thank you. Dr. Michael Ryan: (42:15) I can also point you Jamie to the AOIC's already begun, which is a normal process certainly in our program. We have a constant oversight from an independent advisory and oversight committee, which was constituted by the World Health assembly and the executive board, the chair of the IOAC and the IOAC report directly to the governing bodies of the organization. And their mandate is to constantly oversee the performance of the WHO Emergencies Program and WHO's overall performance in emergency response. We've been reviewing every single response that we have through that process. Dr. Michael Ryan: (42:56) The IOAC has visited country after country, including DR Congo. It has visited the middle eastern countries. It has visited countries in Asia. It has visited Cox bazar has visited so many other places in which not only does it do reviews of our performance on paper, but it does direct field missions to review our performance in the field. At regional level, it speaks to partners. It interviews and deals with many other agencies, constantly seeking to improve the performance of this program, constantly seeking the constructive inputs that are required for Dr. Tedros, myself and others, to ensure that this program is living up to its establishment. Dr. Michael Ryan: (43:38) We will continue to do that as part of the interim process. The decision then for a broader review will come in its own time, but I can assure you that we are constantly reviewing our performance, constantly reviewing what we do, where we do with how we do it, because that is the role and the instinct of an emergencies program is to constantly understand that emergencies in themselves are dynamic. Emergencies are challenging. Epidemics information evolves, and one must always remain open to changing direction, to changing approaches and learning and doing differently when necessary. That is the essence and the DNA of this program. And we will continue to do that with the guidance of the IOAC and our governing bodies. The director general will institute a broader evaluation as has been done in previous major events that is usually reserved until those events are over. Dr. Michael Ryan: (44:34) I point you, again, we have one operative paragraph calling onto WHO and member states to do an evaluation. We have more than 34 other instructions that are aimed at ending and controlling this pandemic. I for one would prefer right now to get on with doing the job of emergency response of epidemic control, of developing and distributing vaccines, of improving our surveillance, of saving lives and then distributing essential PPE to workers and finding medical oxygen for people in fragile settings, in reducing the impact of this disease and refugees and migrants. When the time is right, the director general will in consultation with the member states carry out the appropriate evaluations and reviews. Dr Tedros: (45:19) By the way, thank you. Thank you, Mike. Jeremy, I would actually like to invite you to read the independence, the IOAC report that was released actually on Monday, and they have already done their assessment from January to April. And that's why I tanked Dr. Felicity Harvey and the team of the IOAC, the independent assessment committee for their work. So we do it regularly. And the one which will be a comprehensive one, as we said, will be done at the earliest time possible, but still it should really not cause a problem in our response because the most important thing now is fighting the fire, saving lives. But at the same time, we should also do the assessments, but it doesn't mean that we haven't done independent assessment. It was already done. And I would encourage you to read that report from IOAC. Thank you. Tarik: (46:36) We have time for one or two more questions. So let's try to get Jason Beaubien from National Public Radio. Jason, are you with us? Hello, Jason from NPR? Jason Beaubien: (46:53) Okay. All right. Unmuted now. Can you hear me? Tarik: (46:56) Yes. Jason Beaubien: (46:57) Okay. I just wanted to ask whether you have actually gotten a clearer sense what the west is looking for. I know you've gone over this, but this is a huge potential of pullback if such a major donor comes out. The US has said that they have been in discussions with the WHO. Is it clear what they are looking for from you in terms of reforms? Dr Tedros: (47:25) I think this has been answered, but maybe Mike wants to. Dr. Michael Ryan: (47:28) Yeah, I think you might want to point that question to them. Tarik: (47:33) Well, Jason, maybe you have not been listening the rest of the briefing, but this has been discussed. Let's try to get Lisa Schnirring from CIDRAP. Lisa, are you here with us, Lisa? Lisa Schnirring: (47:50) Yeah. Thanks for taking my question. There were a couple interesting reports out today about some unusual presentations. One a report I saw on ProMED about more of the GI presentation. And then there were other reports out of Northeast China, about more of a longer incubation and more of a focus lung pathology situation. Just wondering how we should take those right now, how we should understand those types of reports. Thanks so much. Dr. Maria Van Kerkhove: (48:27) So, Lisa, thank you so much for that question. I think exactly the question that you have points out the fact that this is still a virus that we're learning about and we're learning every day about this virus. We are so grateful for the clinicians and nurses and medical professionals that are fighting so hard to care for patients and to treat those patients in some very difficult situations. We have our clinical network, as I've mentioned several times in these press conferences, and the clinical network is a global group of medical professionals that are dealing with patients directly, firsthand knowledge of dealing with patients. This clinical network was set up in early January specifically to put people in touch with one another to say, "What are you seeing? What are the patients presenting with? How are they progressing to severe disease or not?" Dr. Maria Van Kerkhove: (49:24) What they're doing constantly, they're having these teleconferences at least once a week. We will have new clinical guidance and update to our clinical guidance, which will come out hopefully by Friday of this week in the coming days. The most common symptoms that we are aware of from a pooling of information globally, and I should also say, this is why it's important that a standardized set of data is collected from patients. We have case report forms that are for this. The most common symptoms of people with COVID-19 are fever, cough, fatigue, shortness of breath, feeling generally unwell, some aches and pains, but we do have some nonspecific symptoms that people have reported, including headache. Some of them have gastrointestinal symptoms between three and 5% of patients have reported some kind of either nausea or vomiting or diarrhea, so it seems to be rare. We do have individuals who have reported loss of taste and loss of smell. Dr. Maria Van Kerkhove: (50:28) And so, but as you point out, the more that we're learning, it's important to put each of these symptoms into context and say, is this part of the clinical picture? Is this part of the disease that people are experiencing? And for me, and for others, what's also important is how do people start off? Not everybody starts with a fever. Some people may be feeling just generally unwell, a little bit fatigued, may have a bit of a headache. And so it's important that we, how people progress and if that's different for children versus adults, versus people who have underlying conditions. All of these factors are really important for us to better understand how to care for people and to ensure that the clinical pathway that someone goes on or is part of in terms of how we care for them is appropriate. These reports are very important and it's great that clinicians and individuals are making these known because this fills our understanding of what disease COVID-19 causes. Dr. Michael Ryan: (51:31) If I can just supplement, we will soon reach the tragic milestone of five million cases. And as I said in the previous presser, sometimes rare symptoms become seen because in a very extensive set of people infected more rare syndromes or more rare presentations of that disease can be seen. We've seen that with children presenting with hyper inflammatory syndromes. That is not to say that the virus itself is changing and it's not to say that the virus is changing its nature. However, it's really important that we track three things. Dr. Michael Ryan: (52:11) We need to track the infection, the virus itself, as it spreads around the world. We need to track its transmission dynamics to ensure that we understand how it's transmitting, where it's transmitting. We need to track the genetic sequences of the virus to ensure that the virus is not evolving in a way that's negative. Viruses can involve in two ways. They can evolve positively in becoming less pathogenic, and they can involve negatively and becoming more virulent or pathogenic. We also have to track the clinical syndrome to be able to check whether any changes in the virus are resulting in any differences in the clinical attack rate or clinical fatality or clinical syndromes that are presenting. It's really important that we're able to track all three of those parameters and more in real time, over time. That's why we need multiple countries, all countries involved in a global effort to share information, to share data, to share data on the clinical syndrome, data on cases, data on the genetic sequencing. Dr. Michael Ryan: (53:09) It's by pulling all of that detective work together, that we can keep an eye, a very close eye on this virus while we attempt to contain, to control it and develop the vaccines that we need. It's also important for vaccine development that we continue to track the virus and ensure that any vaccine developed is effective against the virus at that time. I think this speaks to our need to constantly listen to clinicians who are observing new presentations to bring that information to the center and share with everyone. It is the essence of what the World Health Organization does every day in collaboration with our member states and countries and territories all around the world. Tarik: (53:56) Thank you very much for this question, Liza, and for answers, we will conclude this press briefing here. We will send you audio file very soon, and then transcript will be available tomorrow. We apologize to all journalists who didn't have opportunity to ask questions this time, but we try really to get as many different people to get their question and to be able to get the information they need. I wish everyone a very nice evening. Dr Tedros: (54:30) Thank you. Thank you, Tarik. Thank you so much. And thank you all for joining us and hoping to see you on Friday. Thank you.